OP-ED

Op-Ed: Jump-Starting Health IT – Best $20 Billion You’ll Ever Spend

An Open Letter to President Obama and the Congress

Please accept my heartfelt congratulations for recognizing health information technology (IT) as one of the most promising targets for public investment at this crucial moment.

As a (formerly practicing) doctor, I’d diagnose our economy on the verge of a Code Blue, and our healthcare system with a more chronic but equally threatening condition.  You’ve recognized how these two illnesses interrelate, with spiraling healthcare costs damaging business competitiveness and job losses threatening healthcare coverage.  If I may offer a second opinion, I concur 100% with your decision to apply the chest paddles now, charged with $20 billion of investment.

Now I would like to offer this promise: I and my fellow health IT leaders are passionately committed to ensuring that this treatment not only succeeds, but delivers a substantial positive return far exceeding the amount invested.  How can we be so confident?  Well, even a 1% improvement in the efficiency of our $2.2 trillion healthcare spend would put us in positive payback territory.  But we can do better than that, and here’s why:

Health IT Products are Ready Right Now   I chair a nonprofit organization that tests and certifies health IT products, so I’m very familiar with the state of that industry and the behavior of potential purchasers.  In the past three years, we’ve certified over 160 electronic health record (EHR) products for doctors’ offices, hospitals, emergency departments, and more.  We rigorously check not just what the software can do, but also for interoperability – the ability to share information with other providers — and the security of the systems as well, all against established standards.  Most doctors know they need EHRs and many will respond to an economic push right now.  And the industry supplying those EHRs is a competitive, diverse marketplace that will respond to growing demand with increased capital investment and job growth.We’ve Learned How to Structure Incentives toward the Desired OutcomesNobody is advocating a massive, unqualified handout of dollars to doctors.  Outright grants may be appropriate for providers in rural and underserved areas, and for safety-net clinics, but in other environments financial incentives should be structured as a series of incremental rewards for progressive achievements.  In the private sector, the Bridges to Excellence program sets an excellent example, while the recently launched Medicare EHR Demo provides a public sector prototype.  These programs offer initial incentive payments for purchasing appropriate technology – a certified EHR — then a second round of money when successfully implemented.  Beyond that, bonuses are paid only as the provider demonstrates improvements in quality or efficiency.  Healthcare payment reform and healthcare IT — twins separated at birth – must grow up and mature together to achieve their full potential.  An Investment in Human CapitalEvery experienced IT hand knows technology is just a tool, and returns on IT investment require strong leadership and dedicated change management.  So some of the stimulus funds should be used to develop the skilled workforce needed.  It may be possible to redeploy IT personnel from other industries to lay broadband infrastructure for healthcare, but we’ll also need to boost health IT training programs.  And doctors and nurses being asked to change their habits are best motivated by one of their own – a clinician champion.  There are plenty of clinicians who have successfully led these projects, and we can’t afford to have their experience locked up within their own organizations — let’s find a way to put them on a health IT inspirational speaking circuit.

Empowering PatientsYou’ve also wisely recognized the need to redirect our health efforts toward prevention, helping people make better choices early in life, and eventually reducing the burden of expensive interventions near the end.  To do this, we need to empower citizens with health knowledge, allowing them to make better health choices and to become more discriminating healthcare consumers.  Personal Health Records (PHRs) will emerge as a platform for this new information flow.  The organization I lead is also preparing to certify these PHRs, to ensure they are secure, private, and can exchange information with EHR systems in doctors’ offices and hospitals.  Projects in this field are a promising area for government investment.The Final Frontier: Healthcare ReformYou’ve recognized the need for dramatic improvements in healthcare, but you’ve decided not to attempt a radical rip-and-replace approach.  That’s a wise choice.  In many towns, hospitals themselves are the major source of jobs; a massive disruption could even shut them down and further weaken the economy.  Fortunately, almost every illness of our current model is amenable to improvement with an assist from better information.  With better data on prices charged and quality of care delivered, we can reform payment to reward clinicians for the quality or their work, instead of just for the quantity.  With EHRs that easily intercommunicate, we can reward better teamwork among providers to re-integrate care despite our fragmented healthcare business model.  And with empowered health consumers and an online connection that extends beyond the occasional visit to the doctor, we can motivate healthy lifestyles and prevention, eventually reversing the growing burden of chronic diseases. We’re Charged Up:  Just Push the ButtonFinally, I see that you understand what is needed to revive our economy: an injection of fiscal stimulus, a steady dose of inspirational leadership, and a big response of energy and optimism from the American people.  So you will be pleased to hear that the health IT community is charged up with those qualities right now.  At our organization, just one of several initiatives in health IT, we’ve seen some two hundred unpaid volunteers serve tirelessly for over three years, and they’re ready to do more.Paddles: charged.  Pathway: clear.  Just push the button, and a new vital rhythm in healthcare will begin.    — Mark Leavitt, MD, PhD   Dr. Leavitt is chairman of the Certification Commission for Healthcare Information Technology, a nonprofit organization with the mission of accelerating the adoption of robust, interoperable health IT.

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alborgMarc ProbstRick HansenreefdiverNeal Kaufman, MD Recent comment authors
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alborg
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Dr. Leavitt:
It’s obvious that YOU don’t use a c-EHR system. This forced HIT use will fail as it is obvious that physicians don’t want to use c-EHRs,don’t want to have e-prescribing and feel that P4P is a waste of their time and efforts to try to see patients to make a living.
This mandate will only make it more costly to see patients for what? EHR systems have yet to significantly show an increase in quality, decreased errors, and most importantly, a ROI.
Al Borges, MD

Marc Probst
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Marc Probst

$20 billion on HIT could make a huge difference in healthcare…but only IF it is spent on the right things in the right way. If this spending continues to proliferate disparate EMR systems, that produce unusable data and require herculean efforts to adapt and modfiy (read this as basically all existing systems) – then this will be a gimmicky approach akin to what WellPoiint tried just a few years ago. However, properly thought through, looking at organizations that have achieved great succes through HIT and building a firm foundation upon proven medical informatic principles, then this $20 billion could do… Read more »

Rick Hansen
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Rick Hansen

Dr. Leavitt: EMR is a great tool and part of the evolution of improving the collecting, storing, and retrieving of information. However, the accretion that EMR will reduce cost and improve quality of care is not the case. Reviewing several physician offices whom have implemented EMR, their costs have increased to the end customer. This is in part by design of the EMR software that is driven by questions and can easily jump a 99212 visit to a 99213 in less time than a physician spends on a traditional 99212 visit. From that standpoint EMR is a great revenue increasing… Read more »

reefdiver
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reefdiver

Mr. Leavitt…many of the BENEFITS you point out in the adoption of EMR, including the efforts of CCHIT to help bring standards to the fray, are still just POTENTIAL. With the EMR adoption rate still suffering better than 50% failures and the successful usage set at under 17% for even partial usage across the US (by the recent NEJM study)how can we say this is a good thing? Put another way, there is no reason to believe the SAME products will have any better success rate going forward…and that would mean that potentially $10 Billion or more of the proposed… Read more »

Neal Kaufman, MD
Guest

All this talk about the EMR/PHR/EHR is ignoring one important aspect…the need for all this connectvitiy to actually help a patient overcome his or her barriers to action…barriers to healthy behaviors.. that absence of which contribute a great deal (some estimate 40%) of the cause of morbidity and mortality in the US. Modern technology has a key role in making this happen if and only if organized medicine provides patients with the day-to-day support they need to prevent disease and to self-manage their conditions if they are ill. In the connected era that means just in time delivery of the… Read more »

PKinSFLA
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PKinSFLA

Thanks for the compliment BevMD. I wish I could have proof read that before posting. WHat I find missing here in IT discussions OF EMR is what does this mean to the patient, the MD and the person who has to pay for it? In other words, you need to show concrete examples of where time and money is spent and what is the increase in quality which can then be measured as value. Let me give you an example of what I would find to be a simple task that a well crafted EMR system would do which would… Read more »

Lone Consumer Voice
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Lone Consumer Voice

Honestly, it is amazing the energy, passion and creativity that happens when you dangle 20 billion dollars in front of people. There is more then enough for vendors, groups that support them, providers, Health 2.0 consultants, insurance companies, government agencies (where are the patients in all of this)to benefit. It HIT the new surrogate for Rep vs Dem? Free market vs Government intervention? Perhaps there is a new collaborative hybrid model that brings vendors, supplies, and customers all to the same table? Something akin to the government, NGO and private sector response to Tsunamis? There is more then enough room… Read more »

Randall Oates, M.D.
Guest

If the goal is to promote EMR adoption, we must have a certification process. Until the certification process has more relevance to the majority of patients and the doctors deserving of their trust, our efforts will continue to falter. The majority of patients receive care from physicians in small practices. The CCHIT 100% required functionalities should be limited to a subset of the current requirements, and should only be those that are relevant to small practices. The 100% pass functions should simply pass a review by clinical representatives that are active in the small practice setting. The remaining functionalities should… Read more »

Tim Elwell
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Tim Elwell

Dr. Larry Weed introduced the first EMR is 1966. It was called the “Problem Oriented Medical Record” or POMS. This innovation out of the University of Vermont held great promise. Now, over 40 years later, EMR adoption is between 12-15% and even less in the small provider office setting. In our (healthcare IT) industry, ‘outcomes’ are delivered in many flavors. To the EMR industry, ‘adoption’ is equivalent to ‘outcomes’. If the consumer isn’t buying, there is a reason and any investment that rewards failure doesn’t seem to be the right answer. Although laudable in principle, certification actually paralyzes innovation. I… Read more »

Christine
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Christine

Practitioners in the new medical-business are geared toward routine, discipline and profit, not innovation. Should large amounts of taxpayer money be lavished on the medical profession, patients need to be in a supervising capacity. Otherwise, taxpayers will donate to the cause only to have doctors respond, “Patient! What patient? I’ve already done you an immense favor modernizing my billing system and communicating with colleagues on your behalf, and you want MORE?” The author needs to check out e-patients.net, particularly their White Paper. Your assumptions about innovation and proactivity, while well intentioned, are flawed and out of date. – Oliver

Vince Kuraitis
Guest

Dr. Leavitt, as I wrote in my first comment, your statements continue to be MISLEADING. I would expect more precision in use of words from someone in your position. A main heading in your post is: “Health IT Products are Ready Right Now” I suggested that today’s EHRs are not interoperable. Your response is that interoperability is not all or nothing. Agreed. Your comeback is that “Today’s certified office EHRs can receive lab reports electronically, and do electronic prescribing”. Again, this MISLEADING statement does not support your conclusion that “Health IT Products Are Ready Right Now” and that “We rigorously… Read more »

bev MD
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bev MD

PKinSFLA has many, many excellent and practical suggestions. In fact, better than most “expert” posts about health IT that I have seen on this blog. The devil is in the details and this commenter understands the details. I suggest, PKinSFLA, that you send your comment to Mr. Daschle et al because truly, many of these people have no idea what’s really needed. One used to be able to enter a suggestion at change.gov; I believe that URL will guide you to his new website, which is something like whitehouse.gov.

mgastl
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mgastl

Dr. Leavitt, I have no objections to a certifying body for EHRs. However, I do have the following issues with the current modus operandi of CCHIT: 1) There should be no vendor involvement in the certification process in any capacity even if there are other experts involved and the large vendors are a minority. This will preserve some appearance of fair play. 2) The cost of certification should be drastically reduced, so it is not prohibitive to smaller vendors, who may very well be the only road to innovation. 3) The feature lists for certification should be reduced to a… Read more »

Mark Leavitt
Guest

I’m glad my post has stimulated so much discussion and I appreciate the questions. Peter and rbar advocate that health reform should come before EHR adoption, not after. I agree — we mustn’t adopt EHRs, then neglect health reform. But how can we reform our health care spending if we don’t know the quality and effectiveness of what we’re buying, and how could we know those things while the source of information is scribbles on paper? Vince Kuraitis, mgastl, and Brian Klepper appear to feel that interoperability is an all or nothing attribute: it’s either perfect, or its worthless. But… Read more »

Brian Klepper
Guest

Dr. Leavitt: As Vince Kuraitis and other commenters point out, your claims that the CCHIT certification process produces interoperability in the EHRs currently on the market is patently false. Send a record from, say, a Centricity (GE) system to an Allscripts system and the information doesn’t flow through from the fields in one to those in the other. That means they’re NOT interoperable. And it also means that if we spent immense dollars buying these tools for physicians, we won’t have improved the lack of communications among them very much. Your post waves the banner for the industry, which is… Read more »